The Officer Will See You Now
Content
May M 6, 2010
Policy Briefi Paper ing
Tr reatment, Not Punishment: Untang gling the Me ental Health Juvenile Jus stice Knot Josette Saxton, Men Health P ntal Policy Associate jsa axton@texa anscareforch hildren.org
In adolescenc mental illn ce, ness is far more prevalent than most people realiz ze—and treat tment much harder to i come by. App c proximately 1 in 5 youth have a diagno osable mental health disor l rder, while m many others st truggle to succeed in the families, socially, and in school due to less severe behavioral or emotional issues. Unfortunately, s eir n e not n all have access to the supports and services show to help ch s wn hildren and th families a heir address emot tional and behavioral ch b hallenges. Ma families cannot afford mental hea treatment and lack coverage for it: Texas any d alth r le eads the nati in the percentage of c ion children with no health in nsurance at all,ii and, among the kids e eligible for public menta health ser p al rvices in Tex xas, only 18% receive th % hem.iii Lack o awareness misidentifi of s, ication of symptoms, sc s carce and uncoordinated resources, and poor c d communicatio are just some of the barriers on e preventing ch p hildren and yo outh from acc cessing appro opriate menta health treat al tment. At A the same time, a disproportionate number of y youth with m mental disord ders are ending up in the juvenile e justice system As some delinquent behaviors stem from untrea m. m ated mental h health and su ubstance abuse issues, national studies estimate that about 7 n 70% of youth in the juve h enile justice s system have a diagnosable mental health disorde iv h er. The T Texas Juvenile Probation Commis ssion (TJPC) reports that in 2006, 41% of its youth had ment health % tal problems and 46% were ch p d hemically dep pendent.v The Texas Youth Commission (TYC) report that in 200 32% of e h n ts 08, it committed youth had serious menta health problems and 36 were chemically dependent.vi Both agencies ts d s al 6% h vii acknowledge substantial gaps between identified m a g n mental health needs and services prov h vided. Altho ough they have made pr h rogress in ref forming the w they serv youth, the juvenile justice system is not the plac to treat way ve ce mental disord m ders, nor has it been show to be effec wn ctive in preve enting further delinquent b r behavior in youth with mental impair m rment. What’s happe W ening? Too lit focus on t promotio of children social and emotional he ttle the on n’s ealth, inappro opriate or missed identif m fication of mental health issues, and la of access to appropria treatment and supports has led ack ate t to t the juvenile justice syst tem becoming the de fact provider of mental health services f children in Texas.viii to for n This T happens even as an alternative tha is well esta at ablished to im mprove outco omes and to s save the public money exists: early re e ecognition an treatment of mental he nd ealth disorder in a commu rs unity setting.ix While Texas must improv care and treatment o juvenile of W ve of ffenders with mental hea h alth needs w who enter custody, steps can be take before children with m c en mental health challenges come into con ntact with the juvenile e justice system and prevent their entering what shou after all, be a system of last resort Community supports m t uld, t. y can help the c ese youth successfully r s remain in th heir families and comm s munities and prevent them from unnecessarily cycling into the juvenile ju u y t ustice system or “graduati m ing” into the adult crimina justice syste al em.
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Promoting Mental Health, Preventing Escalating Problems Health Coverage and Access to Mental Health Treatment: Access to health care is a prime component of supporting children’s physical, social, and emotional health. Primary care providers are in a key position to identify and address children’s behavioral health needs early, referring children and families to appropriate treatment and resources as needed. However, not all doctors screen for social, emotional, and behavioral concerns during well child visits,x missing a valuable opportunity to help identify problems early when they are easier and less costly to treat. When problems are detected, families with private insurance plans often find limited coverage for mental and behavioral health treatment and frequently face caps for whatever services are covered.xi Moderate and low income children enrolled in the state Children’s Health Insurance Program (CHIP) or Children’s Medicaid have mental health coverage, yet these benefits tend to be underutilized because many mental health providers don’t accept public coverage. Additionally, many children are eligible for CHIP and Medicaid but not enrolled, either because their families don’t know they qualify or because the state fails to process their applications in a timely way.xii The public mental health system serves children with no health insurance and provides a wide array of services. However, low funding means four out of five eligible children fail to receive services. Finally, many Texas families earn too much to qualify for public coverage but not enough to pay for expensive private insurance comprehensive enough to meet their children’s needs. The Role of Public Schools: Schools provide a natural environment to both identify and address students’ mental and behavioral issues. Unfortunately, many schools respond to students with behavior problems by removing them from their classrooms and placing them into more restrictive environments, such as alternative education programs located off of school grounds. This practice derails students’ education and wastes valuable opportunities to address underlying causes of problem behaviors with appropriate interventions.
School Interventions in Texas Various initiatives are available to assist schools in supporting the social and emotional health of their students, to address problem behaviors, and to coordinate community resources available to help students succeed. In 2001, the Texas Legislature established the Texas Behavior Support Initiative within the Texas Education Agency (TEA) to build capacity in schools to use research based practices school wide that encourage positive behaviors. The Texas Collaborative for the Emotional Development in Schools (TxCEDS) is another TEA initiative that assists districts in integrating social and emotional learning into existing school models and promotes collaboration between schools and the community. Texas schools have access to these resources, but they are not required to use them. The Communities in Schools (CIS) program, a best practice in preventing students from dropping out of school, uses a case management model to assist students by providing services directly or linking students with social service providers, public and private agencies, drug education specialists, health professionals, and others in the community to meet each student’s needs. In the 2006 2007 school year, 70% of students served by CIS in Texas were targeted for behavior issues.
Sources: ICF International and the National Dropout Prevention Center/Network. (2008). Best Practices in Drop Out Prevention. http://ritter.tea.state.tx.us/comm/leg_reports/bpdp_finalreport_200 81219_toTEA.pdf: ICF International. (2008). Texas Education Agency, Evaluation of Communities in Schools (CIS) of Texas. http://ritter.tea.state.tx.us/opge/progeval/DropoutPrevention/CIS_of _Texas_Final_Evaluation_2008.pdf
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Positive Behavioral Support (PBS) is an evidence based, data driven framework proven to reduce disciplinary incidents, increase a school’s sense of safety, and support improved academic outcomes.xiii PBS is also the recommended intervention for dealing with challenging behavior in children with disabilities,xiv a population that is overrepresented in the juvenile justice system. Nearly 40% of youth in the Texas juvenile justice system received special education services prior to coming into contact with the system.xv The single greatest predictor of future incarceration is a history of disciplinary referrals at school.xvi Texas schools file more than 20,000 misdemeanor cases to the courts each year for truancy and minor violations of the Texas Education Code, such as disrupting a class or unreasonable noise.xvii This trend of “criminalizing” adolescent behaviors could be reversed if education professionals were sufficiently trained and given resources to manage students in need of behavioral interventions.xviii Positive Youth Development Programs: Youth who feel safe, valued, and connected to caring adults are more likely to feel positive about their lives, be engaged in school, and exhibit good emotional health; they also are less likely to participate in delinquent behavior.xix Research shows positive youth development approaches can result in significant improvements in problem behaviors, including drug and alcohol use, school misbehavior, aggressive behavior, violence, and truancy.xx Communities that ensure an ample and diverse array of positive youth development opportunities are available can help meet the needs of various youth, while working to coordinate the efforts of individual programs.xxi The Seattle Social Development Project, Guiding Good Choices, and Strengthening Families Program for Parents and Youth 10 14 are examples of evidenced based programs that reduce delinquency, lower substance abuse, and increase graduation rates while providing significant returns on investment.xxii Youth with Mental Illness: When youth experience a mental health crisis, responding immediately to their needs is key to preventing them from getting involved with the juvenile justice system unnecessarily. Mobile Crisis Units or Crisis Intervention Teams in some communities provide immediate access to assessment and crisis resolution services wherever the person in crisis is located. However, stabilization is not enough; it is just as critical to link these children and their families to ongoing services to prevent the too familiar cycle of crisis stabilization crisis that many youth and families experience. Typically, the most effective services for youth with serious emotional disturbances are home and community based interventions, as opposed to interventions provided in more restrictive settings, such as psychiatric hospitals, residential treatment centers, or detention centers.xxiii A systems of care, “wraparound” approach is a promising practice in serving both youth with mental health challenges and juvenile offenders.xxiv This strategy provides youth and their families with an array of comprehensive, coordinated services from various agencies and organizations, rather than placing youth into predetermined, inflexible treatment programs. It substantially improves youths’ functioning in their schools, homes, and communities, and can prevent them from coming into contact with the juvenile justice system.xxv Unfortunately, with only limited community based resources, children with mental disorders frequently come into contact with the juvenile justice system.xxvi Services are out of reach to many children and families. In a national survey of families who had a child with a serious mental disorder, 36% of respondents said their child was in the juvenile justice system because of the unavailability of mental health services outside of the system; 23% were told they would have to relinquish custody of their child to get the services they believed necessary; and 20% said they actually relinquished custody to obtain services for their child.xxvii
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Keeping Mentally Ill Offenders from Entering or Penetrating the Juvenile Justice System When youth with mental health challenges engage in delinquent behavior, identifying the issue and diverting these youth from the juvenile justice system and into evidenced based community interventions–i.e., the least restrictive setting possible—benefits the youth and communities alike. Research shows many of the most effective treatment methods work best when applied in the community, while youth are with their families,xxviii whereas interventions in more restrictive residential placements are generally ineffective in producing long term changes in youth behavior.xxix Screenings and assessments: Experts recommend screenings at the earliest point of contact with the juvenile justice system possible to help divert delinquent youth with mental health challenges to appropriate and effective treatment and services. Valid screening instruments can help detect mental health issues, including substance abuse and traumatic stress disorders. Results enable juvenile probation departments or juvenile courts to better identify interventions that will most appropriately meet the youths’ and community’s needs. Community Based Interventions: Remaining in or close to their communities is important for all youth within the juvenile justice system, and perhaps even more so for youth with mental health disorders. Interventions that both address youths’ mental health needs and decrease the chance of future delinquent behavior often include individual and family therapy, medication management, behavioral coaching, and respite care. All reduce psychiatric symptoms, out of home placement, and long term rates of recidivism.xxx Evidence based approaches that work with parents, guardians, and youth at home to improve youths’ behavior include multisystemic therapyxxxi, functional family therapyxxxii, and multidimensional treatment foster carexxxiii, and coordination of services through a wraparound approachxxxiv which is integral to systems of care. Providing delinquent youth with an array of coordinated community services has been shown to result in fewer behavioral and emotional problems after 18 months in a system of care.xxxv
Screening in Texas Local probation departments in Texas are required to do an initial mental health screening when youth are admitted to detention or enter the probation system. The Texas Juvenile Probation Commission is developing a series of juvenile risk assessment instruments for identification of a juvenile’s risk of re offense based on criminal history and needs. Beginning in 2010, youth in the juvenile justice system in pilot areas will be screened for undiagnosed traumatic brain injuries (TBI) that may contribute to delinquent behavior, allowing for more targeted services. However, screenings and assessments do not guarantee treatment. Specialized treatment services are often in short supply or are too expensive for local communities. The majority of youth with mental health disorders served by local probation departments in Texas do not receive treatment. In 2004, 67% of youth served by juvenile probation departments who needed services did not receive them.
Sources: Texas Family Code Sec. 51.21; Texas Juvenile Probation Commission and Juvenile Justice Practitioners. (2008) Texas Juvenile Probation: Today and Tomorrow. http://www.tjpc.state. tx.us/publications/reports/TJPCMISC0308.pdf; Texas Juvenile Probation Commission and Juvenile Justice Practitioners. (2008) Texas Juvenile Probation: Today and Tomorrow. http://www.tjpc.state.tx.us/publications/reports/TJPCMISC03 08. pdf; Texas Juvenile Probation Commission. Models for Change: Systems Reform in Juvenile Justice Grant Application.
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Community Based Practices in Texas Role of the Judicial System in Diverting Youth: The juvenile courts play an important role in making sure delinquent youth with mental health issues receive appropriate treatment. Courts in Texas can order a mental health evaluation at any stage of court proceedings, and local probation departments are required to refer the child to the local community mental health center for further evaluation and services if testing indicates a suspected mental illness.xxxvi When families have access to adequate legal defense to help them focus on securing appropriate community based services, youth are able to remain in their homes or be placed in less restrictive settings.xxxvii Mental Health and Drug Courts are emerging as promising alternatives to more traditional courts to address juvenile offenders’ mental and substance use issues, while also addressing public safety.xxxviii Mental health courts link offenders who would ordinarily be prison bound to long term community based treatment. Drug courts provide court supervised treatment as an alternative to traditional criminal sanctions. There are several promising diversion practices underway in the state: Dallas and Harris counties are participating in the Annie E. Casey Foundation funded Juvenile Detention Alternatives Initiative (JDAI). JDAI targets the detention component of the juvenile justice system for diversion efforts by helping communities devise systems and procedures to help make sure only youth awaiting trial who need to be detained are held in detention centers and diverting other youth to community based alternatives. The Front End Diversion Initiative is an intake based diversion effort that provides family engagement, motivational interviewing, crisis intervention, and mental health training to specialized juvenile probation officers to help them better identify and work with youth with mental health challenges. The Special Needs Diversionary Program pairs a specialized probation officer with a local mental health professional to provide the offender and his/her family coordinated community based case management services, such as skills training, anger management, medication maintenance, and group therapy. The Youth Empowerment Services Medicaid waiver pilot program, being implemented in Bexar and Travis counties, will provide intensive community based services for youth and children with severe emotional disturbances to reduce out of home placements by all child serving agencies, including the juvenile justice system agencies. Bexar County is a demonstration site for a behavioral health intervention pilot project to divert children and youth at risk of being removed from their home into integrated systems of care implemented by local and state child serving agencies, including the local mental health authority and TYC.
Sources: The Annie E. Casey Foundation. (2009) Two Decades of JDAI: A Progress Report http://www.jdaihelpdesk.org/Docs/Documents/ JDAI_Natl_Report_r6.pdf; Texas Juvenile Probation Commission. (2009). Front End Diversion Initiative Program: Policy and Procedure Manual Overview; Texas Juvenile Probation Commission. (2008) Overview of the Special Needs Diversionary Program for Mentally Ill Juvenile Offenders, FY 2007.
Judicial Diversion in Texas Specialized court programs are unavailable to the majority of juveniles in Texas, but some communities are implementing this promising practice. One example is Travis County’s COPE Mental Health Court, which links youth with a mental health disorder or diagnosis that has led to the commission of a criminal offense to community mental health services, therapeutic services, and other services as needed by the family. The Bexar County Mental Health Court for Female Juvenile Offenders diverts young delinquent females who have been traumatized into treatment and away from further criminal justice system involvement. The Tarrant County Juvenile Drug Court targets juvenile offenders referred for substance abuse offenses and gives them opportunities to get support that will improve their decision making, skills, and health.
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Mental Health Treatment during Incarceration Some delinquent youth will need to be placed in secure facilities, due to concerns for public safety or chronic reoffending. However, in general, merely incarcerating youth has proven ineffective in changing behavior once they are released back into their homes and communities.xxxix Providing mental health treatment during incarceration, however, can improve outcomes. A TYC study found that youth who received mental health treatment while incarcerated were significantly less likely to be rearrested or reincarcerated after one year following their release.xl Conducting comprehensive psychological assessments on all juvenile offenders upon commitment would allow juvenile justice agencies to identify previously undiagnosed mental health needs and develop individualized treatment plans, including planning for youths’ return to their families and communities. Interventions that are tailored to the youths’ individual needs and evidenced based hold the most promise. Evidence based practices, such as cognitive behavioral therapy, specialized substance abuse treatment, integrated treatment for dually diagnosed youth, and trauma informed care, are key to treating incarcerated juvenile offenders.xli Research notes the importance of specialized treatment, provided by qualified professionals with extensive training, which has proven more effective than similar programs administered by regular correctional staff.xlii Even when youth are incarcerated, families can be involved in the treatment plan to enhance effectiveness. Small, Regional Facilities and Trained Staff: Secure juvenile justice facilities that serve a small number of offenders and are located as close to the communities youth come from as possible bring better outcomes for incarcerated youth. This practice has been implemented in the Missouri juvenile correction system and is sometimes referred to as the “Missouri Model.” Additionally, ensuring facility staff use a youth focused and strength based approach, have adequate training to work with youth (e.g., training in strategies to defuse escalating situations), and can maintain low youth to staff ratios is beneficial.xliii In contrast, the use of seclusion and restraints, including using medication as a means of chemical restraint, poses serious health and safety risks to youth, and prevents youth from learning appropriate coping skills.xliv
The Targeted Approach in Texas Youth incarcerated within TYC continue to be housed in large facilities, most often far from their families and communities. Lawmakers and advocates are closely watching the outcomes of newly implemented reforms within the Commission. In response to juvenile justice reform passed by the state legislature in 2007, TYC implemented the ConNEXTtions program, an integrated system wide rehabilitation program offering various therapeutic techniques and tools for youth in TYC facilities. ConNEXTions uses an evidence based assessment on all youth, with assessment results forming the basis for individual treatment plans. In addition to general programming, youth may be required to attend supplemental groups to assist them in areas such as mental health support, alcohol and drug education, anger management, or psychosexual development. Youth diagnosed with severe mental illness may receive treatment at one of two facilities in the state, Corsicana Residential Treatment Center or Crockett State School.
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Reentry into the Community and Aftercare Services Most youth involved in the juvenile justice system will return to their families and communities. Planning for this reentry is a critical piece in preventing them from cycling back into the juvenile or adult criminal justice systems. Experts recommend beginning planning for reentry soon after a youth enters confinement, taking into account a youth’s family and living arrangements; peer groups; mental, behavioral and physical health; substance abuse treatment needs; and educational plans.xlv Reentry planning and aftercare services following a youth’s return home are model practices in reducing recidivism rates and saving the public money in the long run.xlvi Using a wraparound approach to serve youth leaving a juvenile justice facility is a promising practice that can prevent youth with mental illness from engaging in further delinquent behavior. Such planning is needed for all youth coming out of the juvenile justice system, and it is especially critical for youth with mental health disorders to make sure they have continuing access to services and supports, including mental health treatment, substance abuse treatment, and re enrollment into health coverage. Youth coming out of the juvenile justice system face many of the same challenges as youth aging out of foster care. A new pilot for former juvenile offenders uses a promising strategy several communities are using to help former foster youth. Transition centers are community collaborations that use a one stop model to provide former foster youth with access to health care, job training, skill building, housing, education, and more.xlvii TYC and TJPC have recently partnered with community groups in San Antonio to launch the Children’s Aftercare Reentry Experience (CARE) Project that will provide youth coming out of the juvenile justice system with access to these services through San Antonio’s transitional center. Reentry Services in Texas During its 2009 session, the state legislature enacted several laws to help youth with mental illness leaving the juvenile justice system access supports and services critical to their successful reentry. State agencies are now required to work together to determine a youth’s eligibility for public health benefits upon release as part of the discharge planning process, helping to ensure that qualifying youth can access health care. The Texas Correctional Office on Offenders with Medical or Mental Impairments (TCOOMMI) contracts with public mental health agencies to provide juvenile offenders with serious emotional disturbances with targeted treatment services using a wraparound, case management philosophy, with strong emphasis on flexible programming. TCOOMMI is now also required to coordinate a continuity of care system for juvenile offenders. This continuum of care is to be delivered by various state child serving agencies, including juvenile justice, human services, and education agencies. The continuity of care system was established to address the medical, psychiatric, or psychological needs and care of juvenile offenders with mental illness, along with their education and rehabilitation needs, from the time they enter the enter the juvenile justice system until they are released from supervision into their communities. The state legislature also authorized TCOOMMI to provide community services to youth discharged from TYC due to a mental impairment that precludes them from effectively participating in rehabilitative services. These youth, arguably in the greatest need of ongoing mental health treatment and supports, were previously ineligible for aftercare services through TCOOMMI because they were not placed on parole after discharge.
Sources: Texas Correctional Office on Offenders with Mental or Medical Impairments. (2009). The Biennial Report of the Texas Correctional Office on Offenders with Medical and Mental Impairments. http://www.tdcj.state. tx.us/publications/tcomi/Biennial%20Report%202009%20FINAL.pdf; Texas Health and Safety Code, Section 614.018
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Special Issues and Considerations Co occurring Disorders: Many youth involved with the juvenile justice system have co occurring mental health and substance abuse disorders. Youth with emotional and behavioral problems are almost four times as likely to be dependent on alcohol or drugs, compared to their peers.xlviii Screening and assessment tools used throughout the juvenile justice process can be designed to detect various disorders, including trauma and substance abuse problems. When co occurring disorders are present, integrated treatment is necessary, as are professionals who can effectively treat the multiple needs of youth. Because some youth may return to homes and friends that promoted or supported their drug use, aftercare and relapse prevention services are critical. Youth who continue their substance use upon reentry are more likely to reoffend, and treatment for substance use can reduce continued criminal behavior.xlix Treatment of Young Female Offenders: While females make up a small percentage of youth incarcerated by TYC (just 7% of commitments in 2008), over a quarter of youth referred to TJPC in 2005 were female.l No matter where they are served, young female offenders have different treatment and rehabilitation needs than their male peers.li Young female offenders are more likely to report being the victims of violence and to develop mental health problems following trauma than male juvenile offenders.lii Girls should have access to community based treatment that is gender specific and trauma informed.liii Family Involvement: Having families involved in all aspects of care and treatment for youthliv can help mental health professionals have valuable information key to keeping the youth stable and safe. Even more importantly, families can play an integral, if not essential, part of youths’ treatment and rehabilitation. Multisystemic therapy and functional family therapy, both evidenced based best practices for working with delinquent youth, work with parents, guardians, and youth at home to improve the youth’s behavior and the communication and problem solving skills of parents and siblings. Since most youth return to their families after they leave the juvenile justice system, it is necessary to involve families in planning for successful reentry into their home and community. Families also play a key role in the systems of care approach for youth with serious emotional disturbances. Family partners and family liaisons are valuable approaches to both assist and engage families in supporting their youths’ treatment. To facilitate their involvement, families need information, training, and support at all stages of their child’s experience with the juvenile justice system. Many of Texas’s child and youth serving agencies recognize this and have begun to staff or contract with experienced parents or young adults who have had life experiences and a personal working knowledge of accessing and utilizing the state’s health and human services or juvenile justice systems. These professionals help families navigate the systems to access services. Disproportionate Minority Contact: Youth of color face particular challenges in both the mental health and juvenile justice systems. Compared to their white peers, they are less likely to receive services for mental health concerns;lv when they do receive treatment, it is less likely to be care shown to be effective.lvi Even when evidence based treatments are available, they may not be treatments that have been shown to be effective with youth of color.lvii At the same time, youth of color are overrepresented in the juvenile justice system, nationally and in Texas.lviii,lix While referrals to juvenile probation departments in Texas have decreased by 12% since 2001, the reduction has been almost solely driven by a drop in referrals of white youth; youth of color are referred at roughly the same rate as in previous years.lx Minority students are more likely to receive disciplinary referrals in Texas schools,lxi and they are more likely to be put on probation.lxii The factors influencing the experiences of youth of color within both systems are complex,lxiii but involve practices both in the community, such as differences in school discipline practices that disparately impact youth of color, and in care, such as biases in the legal and justice systems that lead to different outcomes across racial and ethnic groups. Policy and practice 8
must address the gaps in front end contact with the juvenile justice system, as well as ensure the cultural competence of treatment for youth in care. Investing in What Works: Thanks to a growing body of research, much is known about how to effectively address the mental health needs of youth, both in the community and within the juvenile justice system. To ensure the best outcomes for children and families and to make the most of limited public resources, investments need to be linked to evidence based programs, as well as emerging practices that show promise but need further evaluation. Across all programs and systems, objective evaluations, routinely conducted, can help measure progress in client outcomes and to determine cost effectiveness. Return on Investment Community based treatments for youth with mental health challenges are more effective and less expensive than treatments provided in more restrictive environments, such as juvenile justice facilities. Various juvenile delinquency prevention programs have been shown to be effective in not only reducing juvenile criminal behavior, but in saving money by avoiding costs in the juvenile justice system and to victims of juvenile crime.lxiv In 2005, it cost an average of $885 to provide youth with behavioral health services in a community setting in Texas, compared to $8,759 to provide behavioral health services in institutional or residential settings.lxv The average cost to commit a youth to the Texas Youth Commission is $96,000,lxvi compared to approximately $3,000 for providing drug or alcohol rehabilitation.lxvii Separately, untreated mental illness in children and delinquent behavior each inflict a great cost to the public. Since mental health and juvenile delinquency are related and often interconnected, Texas can reap multiple benefits by addressing these issues together. Recommendations To promote resiliency and success in children, keep citizens safe from delinquent activity, and save taxpayers money, Texas should act to ensure children with mental impairments are diverted from the juvenile justice system whenever possible; we must also ensure those who do enter the system receive quality care and that their needs are met as they transition out of the system. DIVERSION Promote school success by requiring school districts to use evidence based models, such as school wide Positive Behavioral Supports, and to train teachers and school staff to recognize potential unmet mental health needs, so they can make appropriate referrals. Continue to repeal zero tolerance policies that criminalize challenging behavior in the school environment. Support keeping kids in the community by making Mobile Crisis Teams available on school campuses. Build community capacity to address mental health needs of children and families, including evidence based treatments addressing the whole child. Decrease reliance on psychotropic medication to control behaviors in children. When such medication is deemed necessary, ensure that its usage is closely monitored and provided in conjunction with other interventions. Improve coordination among agencies and systems serving children and their families. Use multidisciplinary teams as standard practice for assessment and service delivery. Provide flexible funding for Community Resource Coordination Groups (CRCGs) and Texas Integrated Funding Initiative (TIFI)
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sites to provide more children with complex needs access to needed supports and services using a systems of care approach. Expand probation based diversion strategies, such as the Front End Diversion Initiative, to all counties, with specialized officer certification that includes motivational interviewing. Increase use of mental health and drug courts and move all juvenile courts towards treatment based models Ensure that all practices reduce the disproportionate referral of children of color to the juvenile justice system. Make the primary objective of probation supervision rather than sanction. IN CARE Identify youth with mental health challenges when they come into the system. Provide evidence based treatment, such as Cognitive Behavioral Therapy, Multisystemic Therapy, Functional Family Therapy, trauma informed care, and substance abuse treatment. Involve guardians and family of choice in all aspects of youth care. Strategies to better engage families include training juvenile justice staff on how to effectively engage families, exploring the use of family group decision making, and using technology, such as video conferencing, to keep families engaged with incarcerated youth. Given the prevalence of trauma among young female offenders, provide them with community based treatment that is gender specific and trauma informed. In order to address their unique needs, keep children out of the adult criminal justice system. Utilize programs and practices that are culturally competent. Use seclusion and restraints only when there is an imminent risk of danger to the youth or others and no other safe and effective intervention is possible. Medication should not be used as a chemical restraint. Serve youth in small, regionalized facilities close to their communities. Partner with community based organizations to keep youth connected to the community and involved in activities that foster responsibility and self esteem. Promote professionalism among juvenile justice staff. Increase professional requirements, including field experience and training in working with special populations; pay a living wage; and reward staff who work effectively with youth. TRANSITION Begin planning for reentry upon confinement. Provide comprehensive aftercare services to youth coming out of the juvenile justice system to make sure a continuum of care and services is available. Identify and engage a child’s family of choice and help them prepare for the child’s reentry into the community. Take steps to ensure eligible youth are enrolled in Medicaid or CHIP and can begin receiving covered services immediately upon release. Assist youth leaving the juvenile justice system in acquiring the skills and resources needed to succeed in reentry and to prevent recidivism. Provide grants to community based organizations that assist youth in enrolling in school or training; securing employment and safe, stable housing; accessing mental health services; and resolving substance abuse problems. Explore the use of transition centers, such as those serving youth leaving the child welfare system, to assist youth leaving the juvenile justice system. 10
Kessler, R.C.; Berglund, P.; Demler, O.; Jin, R.; Walters, E.E. (2005) Life time Prevalence and Age of onset Distribution of DSM IV Disorders in the National Co morbidity Survey Replication. Archives of General Psychiatry. 62:539 602. ii US Census Bureau. (2009) Income, Poverty, and Health Insurance Coverage in the United States: 2008 http://www.census.gov/prod/2009pubs/p60 236.pdf iii Department of State Health Services. 2007. E mail correspondence with Amanda Broden. iv National Center for Children in Poverty.(2009) Adolescent Mental Health in the United States. http://www.nccp.org/publications/pdf/text_878.pdf v Texas Juvenile Probation Commission.(2008) Models for Change: Systems Reform in Juvenile Justice Grant Application. vi Texas Youth Commission. Who Are TYC Offenders (FY08) http://www.tyc.state.tx.us/research/youth_stats.html vii Texas Juvenile Probation Commission Strategic Plan for 2009 2013 http://www.tjpc.state.tx.us/publications/reports/RPTSTRAT200801.pdf; Texas Youth Commission Review of Agency Treatment Effectiveness, Fiscal Year 2008. viii Texas Juvenile Probation Commission. Models for Change: Systems Reform in Juvenile Justice Grant Application. ix Texas Appleseed. (2009) Creating Flexibility from the Bench: Meeting the Needs of Juveniles with Mental Impairments. http://www.texasappleseed.net x Lavigne J.V., Binns, H.J., Christoffel, K,K. et al. (1993). “Behavioral and emotional problems among preschool children in pediatric primary care: Prevalence and pediatricians’ recognition.” Pediatrics. 91:649 657, as cited in Improving Developmental Screening Through Public Policy http://www.dbpeds.org/articles/detail.cfm?TextID=367 xi Koppelman, Jane. (2005). Mental Health and Juvenile Justice: Moving Toward More Effective Systems of Care. National Health Policy Forum Issue Brief No. 805 xii Texas CHIP Coalition. (2009). Fiscal Facts: Texas CHIP and Children’s Medicaid. http://www.texaschip.org/pdf/Fiscal%20Facts%20 %20CHIP%20and%20Childrens%20Medicaid.pdf xiii Horner, R., Sugai, G., Smolkowski, K., Eber, L., Nakasato, J., Todd, A., and J. Esperanza. (2009). A Randomized, Wait List Controlled Effectiveness Trial Assessing School Wide Positive Behavior Support in Elementary Schools, Journal of Positive Behavior Interventions. Journal of Positive Behavior Interventions, Vol. 11, No. 3, 133 144 ; Sprague, J., and R. Horner (2007) “School Wide Positive Behavioral Supports”, in The Handbook of School Violence and School Safety: From Research to Practice. Shane R. Jimerson & Michael J. Furlong, eds. xiv U.S. Department of Education. (2000). Applying positive behavioral support in schools: Twenty second Annual Report to Congress on the Implementation of the Individuals with Disability Act. xv Springer, D. (2007 Transforming Juvenile Justice in Texas: A Framework for Action – Blue Ribbon Taskforce Report. http://www.dallasnews.com/s/dws/img/09 07/0913tycreport.pdf xvi Public Policy Research Institute, Texas A&M (2005) Study of Minority Over Representation in the Texas Juvenile Justice System. http://dmcfinalreport.tamu.edu/DMRFinalReport.pdf xvii Texas Appleseed. (2009) Creating Flexibility from the Bench: Meeting the Needs of Juveniles with Mental Impairments. http://www.texasappleseed.net xviii Texas Juvenile Probation Commission. (2008) Today and Tomorrow: A Report by the Texas Juvenile Probation Commission and Juvenile Justice Practioners. http://www.tjpc.state.tx.us/publications/reports/TJPCMISC0308.pdf xix National Conference of State Legislatures. (2005). Positive Youth Development: State Strategies. http://www.ncsl.org/Portals/1/documents/cyf/final_positive_youth_development.pdf xx Social Development Research Group, University of Washington. Positive Youth Development in the United States : Research Findings on Evaluations of Positive Youth Development Programs http://aspe.hhs.gov/hsp/PositiveYouthDev99/chapter4.htm xxi Board on Children, Youth and Families. (2002) Community Programs to Promote Youth Development. http://books.nap.edu/openbook.php?record_id=10022&page=1 xxii Promising Practices Network, http://www.promisingpractices.net; National Evaluation Program of the Comprehensive Community Mental Health Services Program for Children and Their Families, Matrix of Children’s Evidence Based Interventions http://systemsofcare.samhsa.gov/headermenus/docsHM/MatrixFINAL1.pdf; Washington State Institute for Public Policy. (2004) Benefits and Costs of Prevention and Early Intervention Programs for Youth. http://www.wsipp.wa.gov/rptfiles/04 07 3901.pdf xxiii Burns, B. & Hoagwood, K. (Eds.). (2002). Community treatment for youth: Evidence based interventions for severe emotional and behavioral disorders. New York: Oxford University Press.
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Pires, S. 2002. Building a Systems of Care: A Primer. National Technical Assistance Center for Children’s Mental Health, Center for Child Health and Mental Health Policy, Georgetown University Child Development Center.; Office of Juvenile Justice and Delinquency Prevention Model Programs Guide. xxv Office of Juvenile Justice and Delinquency Prevention Model Programs Guide. http://www.ojjdp.ncjrs.gov/programs/mpg.html xxvi Texas Appleseed (2009). Creating Flexibility from the Bench: Meeting the Needs of Juveniles with Mental Impairments. http://www.texasappleseed.net xxvii National Alliance for the Mentally Ill (NAMI). (1999). Families on the Brink: The Impact of Ignoring Children with Serious Mental Illness: Results of a National Survey of Parents and Other Caregivers. Arlington, VA: National Alliance for the Mentally Ill. http://www.nami.org/Template.cfm?Section=Child_and_Adolescent_Action_Center&template=/ContentManagement/Con tentDisplay.cfm&ContentID=22196 xxviii Grisso, Thomas. (2008) “Adolescent Offenders with Mental Disorders”. Juvenile Justice, Vol. 18, No. 2. The Future of Children. www.futureofchildren.org xxix National Health Policy Forum. (2005). Mental Health and Juvenile Justice: Moving Toward More Effective Systems of Care. http://www.nhpf.org/library/issue briefs/IB805_JuvJustice_07 22 05.pdf xxx National Health Policy Forum. (2005). Mental Health and Juvenile Justice: Moving Toward More Effective Systems of Care. http://www.nhpf.org/library/issue briefs/IB805_JuvJustice_07 22 05.pdf ; Texas Appleseed (2009). Creating Flexibility from the Bench: Meeting the Needs of Juveniles with Mental Impairments. http://www.texasappleseed.net xxxi Promising Practices Network. http://www.promisingpractices.net/program.asp?programid=81 xxxii Listed as a model program by the Office of Juvenile Justice and Delinquency Prevention; also, Alexander, J.F.; C. Barton; D. Gordon; J. Grotpeter; K. Hansson; R. Harrison; S. Mears; S. Mihalic; B. Parsons; C. Pugh; S. Schulman; H. Waldron; and T. Sexton. (1998). Blueprints for Violence Prevention, Book Three: Functional Family Therapy. Boulder, Colo.: Center for the Study and Prevention of Violence. xxxiii Listed as a model program by the Office of Juvenile Justice and Delinquency Prevention. Also, Chamberlain, Patricia, and Sharon F. Mihalic. 1998. “Multidimensional Treatment Foster Care.” In D.S. Elliott (series ed.) Blueprints for Violence Prevention, Book 8: Multidimensional Treatment Foster Care. Boulder, Colo.: Center for the Study and Prevention of Violence. xxxiv Listed as a model program by the Office of Juvenile Justice and Delinquency Prevention. xxxv National Evaluation Program of the Comprehensive Community Mental Health Services Program for Children and Their Families, Matrix of Children’s Evidence Based Interventions http://systemsofcare.samhsa.gov/headermenus/docsHM/MatrixFINAL1.pdf xxxvi Texas Family Code Sec. 51.20 xxxvii Springer, D. (2007) Transforming Juvenile Justice in Texas: A Framework for Action – Blue Ribbon Taskforce Report. http://www.dallasnews.com/s/dws/img/09 07/0913tycreport.pdf xxxviii National Center for Mental Health and Juvenile Justice. (2006) Juvenile Mental Health Courts: An Emerging Strategy. http://www.ncmhjj.com/pdfs/publications/JuvenileMentalHealthCourts.pdf; Council of State Governments Justice Center (2008). Mental Health Courts: A Primer for Policy Makers and Practitioners. http://consensusproject.org/mhcp/mhc primer.pdf; Office of Juvenile Justice and Delinquency Prevention. xxxix National Health Policy Forum. (2005). Mental Health and Juvenile Justice: Moving Toward More Effective Systems of Care. http://www.nhpf.org/library/issue briefs/IB805_JuvJustice_07 22 05.pdf xl Texas Youth Commission. (2008) Fiscal Year 2008 Review of Agency Treatment Effectiveness. http://www.tyc.state.tx.us/archive/Research/2008_Treatment_Effectiveness.pdf xli Springer, D. (2007) Transforming Juvenile Justice in Texas: A Framework for Action – Blue Ribbon Taskforce Report. http://www.dallasnews.com/s/dws/img/09 07/0913tycreport.pdf; National Center for Mental Health and Juvenile Justice. (2007). “Trauma Among Youth in the Juvenile Justice System: Critical Issues and New Directions.” Research and Program Brief. http://www.ncmhjj.com/pdfs/Trauma_and_Youth.pdf xlii Greenwood, Peter. (2008) “Prevention and Intervention Programs for Juvenile Offenders”. Juvenile Justice, Vol. 18, No. 2. The Future of Children. www.futureofchildren.org
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Springer, D. (2007) Transforming Juvenile Justice in Texas: A Framework for Action – Blue Ribbon Taskforce Report. http://www.dallasnews.com/s/dws/img/09 07/0913tycreport.pdf xliv Donat, D. (2005). “Encouraging alternatives to seclusion, restraint, and reliance on PRN drugs in a public hospital.” Psychiatric Services, 56(9), 1105 1108. xlv Urban Institute Justice Policy Center. (2004). The Dimensions, Pathways, and Consequences of Youth Reentry. xlvi Springer, D. (2007) Transforming Juvenile Justice in Texas: A Framework for Action – Blue Ribbon Taskforce Report. http://www.dallasnews.com/s/dws/img/09 07/0913tycreport.pdf; Urban Institute Justice Policy Center (2004). The Dimensions, Pathways, and Consequences of Youth Reentry. http://www.urban.org/UploadedPDF/410927_youth_reentry.pdf xlvii The Department of Family and Protective Services. http://www.dfps.state.tx.us/Child_Protection/Transitional_Living/forms.asp#transition xlviii U. S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (1999). The Relationship Between Mental Health and Substance Abuse Among Adolescents. Office of Applied Studies. http://www.oas.samhsa.gov/nhsda/a 9/toc.htm xlix Models for Change: Systems Reforms in Juvenile Justice. (2009). Research on Pathways to Desistance: Research Update Created for the 4th Annual Models for Change National Working Conference. http://www.macfound.org/atf/cf/%7Bb0386ce3 8b29 4162 8098 e466fb856794%7D/PATHWAYSREPORT.PDF l Texas Juvenile Probation Commission. (2008) Today and Tomorrow: A Report by the Texas Juvenile Probation Commission and Juvenile Justice Practitioners. http://www.tjpc.state.tx.us/publications/reports/TJPCMISC0308.pdf li National Center for Mental Health and Juvenile Justice. (2003) Adolescent Girls with Mental Health Disorders Involved in the Juvenile Justice System. Research and Program Brief. http://www.ncmhjj.com/pdfs/adol_girls.pdf lii The National Child Traumatic Stress Network. (2004) Trauma Among Girls in the Juvenile Justice System. http://www.nctsnet.org/nctsn_assets/pdfs/edu_materials/trauma_among_girls_in_jjsys.pdf liii Alexander, M. (1996) “Women with Co occurring Addictive and Mental Disorders: An Emerging Profile of Vulnerability. American Journal of Orthopsychiatry, 66, 1; The National Child Traumatic Stress Network. (2004) Trauma Among Girls in the Juvenile Justice System. http://www.nctsnet.org/nctsn_assets/pdfs/edu_materials/trauma_among_girls_in_jjsys.pdf liv National Center for Mental Health and Juvenile Justice. (2002). Involving Families of Youth Who Are in Contact with the Juvenile Justice System. http://www.ncmhjj.com/pdfs/publications/Family.pdf lv Ringel, J. S. & Sturm, R. (2001). National estimates of mental health utilization for children in 1998. Journal of Behavioral Health Services & Research, 28(3), pp. 319 333. lvi Institute of Medicine of the National Academies. (2006). Improving the Quality of Health Care for Mental and Substance Use Conditions: Quality Chasm Series. lvii National Council of La Raza (2008). Overcoming Language and Culture Barriers Using Evidence Based Practice. Prepared for MacArthur Foundation, Models for Change. Washington, DC. lviii National Council of State Legislatures. (2009) Minority Youth in the Juvenile Justice System Disproportionate Minority Contact. http://www.modelsforchange.net/publications/183/Minority_Youth_in_the_Juvenile_Justice_System_Disproportionate_M inority_Contact.pdf lix Texas Juvenile Probation Commission. (2009). The State of Texas Juvenile Probation Activity in Texas – 2007. http://www.tjpc.state.tx.us/publications/reports/RPTSTAT2007.pdf lx Texas Youth Commission and Texas Juvenile Probation Commission Coordinated Strategic Plan. Executive Planning Committee Meeting Packet. October 7, 2009. lxi Texas Appleseed. (2007) Texas’ School to Prison Pipeline: Drop Out to Incarceration. The Impact of School Discipline and Zero Tolerance. http://www.texasappleseed.net/pdf/Pipeline%20Report.pdf lxii Texas Juvenile Probation Commission. (2009). The State of Texas Juvenile Probation Activity in Texas – 2007. http://www.tjpc.state.tx.us/publications/reports/RPTSTAT2007.pdf lxiiilxiii United States Public Health Service Office of the Surgeon General (2001). Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: Department of Health and Human Services, U.S. Public Health Service; and Piquero, Alex. (2008). “Disproportionate Minority Contact”. Juvenile Justice. Vol. 18(2). The Future of Children:Princeton Brookings.
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Washington State Institute for Public Policy. (2001) Comparative Costs and Benefits of Programs to Reduce Crime. http://www.wsipp.wa.gov/pub.asp?docid=01 05 1201 lxv Calculation based on data in Legislative Budget Board 2007 Texas State Government Effectiveness and Efficiency Report; “Create a Coordinated State Infrastructure to Support Children’s Behavioral Health Services”. Figure 5.. http://www.lbb.state.tx.us/Performance%20Reporting/TX_Govt_Effective_Efficiency_Report_80th_0107.pdf lxvi Calculation based on information in the Texas Youth Commission 2009 2013 Agency Strategic Plan. http://www.tyc.state.tx.us/about/strategic_plan.html lxvii Schneider Institute for Health Policy. Brandeis University. (2001) Substance Abuse, The Nation’s Number One Health Problem. http://www.rwjf.org/files/publications/other/SubstanceAbuseChartbook.pdf
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Policy Briefi Paper ing
Tr reatment, Not Punishment: Untang gling the Me ental Health Juvenile Jus stice Knot Josette Saxton, Men Health P ntal Policy Associate jsa axton@texa anscareforch hildren.org
In adolescenc mental illn ce, ness is far more prevalent than most people realiz ze—and treat tment much harder to i come by. App c proximately 1 in 5 youth have a diagno osable mental health disor l rder, while m many others st truggle to succeed in the families, socially, and in school due to less severe behavioral or emotional issues. Unfortunately, s eir n e not n all have access to the supports and services show to help ch s wn hildren and th families a heir address emot tional and behavioral ch b hallenges. Ma families cannot afford mental hea treatment and lack coverage for it: Texas any d alth r le eads the nati in the percentage of c ion children with no health in nsurance at all,ii and, among the kids e eligible for public menta health ser p al rvices in Tex xas, only 18% receive th % hem.iii Lack o awareness misidentifi of s, ication of symptoms, sc s carce and uncoordinated resources, and poor c d communicatio are just some of the barriers on e preventing ch p hildren and yo outh from acc cessing appro opriate menta health treat al tment. At A the same time, a disproportionate number of y youth with m mental disord ders are ending up in the juvenile e justice system As some delinquent behaviors stem from untrea m. m ated mental h health and su ubstance abuse issues, national studies estimate that about 7 n 70% of youth in the juve h enile justice s system have a diagnosable mental health disorde iv h er. The T Texas Juvenile Probation Commis ssion (TJPC) reports that in 2006, 41% of its youth had ment health % tal problems and 46% were ch p d hemically dep pendent.v The Texas Youth Commission (TYC) report that in 200 32% of e h n ts 08, it committed youth had serious menta health problems and 36 were chemically dependent.vi Both agencies ts d s al 6% h vii acknowledge substantial gaps between identified m a g n mental health needs and services prov h vided. Altho ough they have made pr h rogress in ref forming the w they serv youth, the juvenile justice system is not the plac to treat way ve ce mental disord m ders, nor has it been show to be effec wn ctive in preve enting further delinquent b r behavior in youth with mental impair m rment. What’s happe W ening? Too lit focus on t promotio of children social and emotional he ttle the on n’s ealth, inappro opriate or missed identif m fication of mental health issues, and la of access to appropria treatment and supports has led ack ate t to t the juvenile justice syst tem becoming the de fact provider of mental health services f children in Texas.viii to for n This T happens even as an alternative tha is well esta at ablished to im mprove outco omes and to s save the public money exists: early re e ecognition an treatment of mental he nd ealth disorder in a commu rs unity setting.ix While Texas must improv care and treatment o juvenile of W ve of ffenders with mental hea h alth needs w who enter custody, steps can be take before children with m c en mental health challenges come into con ntact with the juvenile e justice system and prevent their entering what shou after all, be a system of last resort Community supports m t uld, t. y can help the c ese youth successfully r s remain in th heir families and comm s munities and prevent them from unnecessarily cycling into the juvenile ju u y t ustice system or “graduati m ing” into the adult crimina justice syste al em.
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Promoting Mental Health, Preventing Escalating Problems Health Coverage and Access to Mental Health Treatment: Access to health care is a prime component of supporting children’s physical, social, and emotional health. Primary care providers are in a key position to identify and address children’s behavioral health needs early, referring children and families to appropriate treatment and resources as needed. However, not all doctors screen for social, emotional, and behavioral concerns during well child visits,x missing a valuable opportunity to help identify problems early when they are easier and less costly to treat. When problems are detected, families with private insurance plans often find limited coverage for mental and behavioral health treatment and frequently face caps for whatever services are covered.xi Moderate and low income children enrolled in the state Children’s Health Insurance Program (CHIP) or Children’s Medicaid have mental health coverage, yet these benefits tend to be underutilized because many mental health providers don’t accept public coverage. Additionally, many children are eligible for CHIP and Medicaid but not enrolled, either because their families don’t know they qualify or because the state fails to process their applications in a timely way.xii The public mental health system serves children with no health insurance and provides a wide array of services. However, low funding means four out of five eligible children fail to receive services. Finally, many Texas families earn too much to qualify for public coverage but not enough to pay for expensive private insurance comprehensive enough to meet their children’s needs. The Role of Public Schools: Schools provide a natural environment to both identify and address students’ mental and behavioral issues. Unfortunately, many schools respond to students with behavior problems by removing them from their classrooms and placing them into more restrictive environments, such as alternative education programs located off of school grounds. This practice derails students’ education and wastes valuable opportunities to address underlying causes of problem behaviors with appropriate interventions.
School Interventions in Texas Various initiatives are available to assist schools in supporting the social and emotional health of their students, to address problem behaviors, and to coordinate community resources available to help students succeed. In 2001, the Texas Legislature established the Texas Behavior Support Initiative within the Texas Education Agency (TEA) to build capacity in schools to use research based practices school wide that encourage positive behaviors. The Texas Collaborative for the Emotional Development in Schools (TxCEDS) is another TEA initiative that assists districts in integrating social and emotional learning into existing school models and promotes collaboration between schools and the community. Texas schools have access to these resources, but they are not required to use them. The Communities in Schools (CIS) program, a best practice in preventing students from dropping out of school, uses a case management model to assist students by providing services directly or linking students with social service providers, public and private agencies, drug education specialists, health professionals, and others in the community to meet each student’s needs. In the 2006 2007 school year, 70% of students served by CIS in Texas were targeted for behavior issues.
Sources: ICF International and the National Dropout Prevention Center/Network. (2008). Best Practices in Drop Out Prevention. http://ritter.tea.state.tx.us/comm/leg_reports/bpdp_finalreport_200 81219_toTEA.pdf: ICF International. (2008). Texas Education Agency, Evaluation of Communities in Schools (CIS) of Texas. http://ritter.tea.state.tx.us/opge/progeval/DropoutPrevention/CIS_of _Texas_Final_Evaluation_2008.pdf
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Positive Behavioral Support (PBS) is an evidence based, data driven framework proven to reduce disciplinary incidents, increase a school’s sense of safety, and support improved academic outcomes.xiii PBS is also the recommended intervention for dealing with challenging behavior in children with disabilities,xiv a population that is overrepresented in the juvenile justice system. Nearly 40% of youth in the Texas juvenile justice system received special education services prior to coming into contact with the system.xv The single greatest predictor of future incarceration is a history of disciplinary referrals at school.xvi Texas schools file more than 20,000 misdemeanor cases to the courts each year for truancy and minor violations of the Texas Education Code, such as disrupting a class or unreasonable noise.xvii This trend of “criminalizing” adolescent behaviors could be reversed if education professionals were sufficiently trained and given resources to manage students in need of behavioral interventions.xviii Positive Youth Development Programs: Youth who feel safe, valued, and connected to caring adults are more likely to feel positive about their lives, be engaged in school, and exhibit good emotional health; they also are less likely to participate in delinquent behavior.xix Research shows positive youth development approaches can result in significant improvements in problem behaviors, including drug and alcohol use, school misbehavior, aggressive behavior, violence, and truancy.xx Communities that ensure an ample and diverse array of positive youth development opportunities are available can help meet the needs of various youth, while working to coordinate the efforts of individual programs.xxi The Seattle Social Development Project, Guiding Good Choices, and Strengthening Families Program for Parents and Youth 10 14 are examples of evidenced based programs that reduce delinquency, lower substance abuse, and increase graduation rates while providing significant returns on investment.xxii Youth with Mental Illness: When youth experience a mental health crisis, responding immediately to their needs is key to preventing them from getting involved with the juvenile justice system unnecessarily. Mobile Crisis Units or Crisis Intervention Teams in some communities provide immediate access to assessment and crisis resolution services wherever the person in crisis is located. However, stabilization is not enough; it is just as critical to link these children and their families to ongoing services to prevent the too familiar cycle of crisis stabilization crisis that many youth and families experience. Typically, the most effective services for youth with serious emotional disturbances are home and community based interventions, as opposed to interventions provided in more restrictive settings, such as psychiatric hospitals, residential treatment centers, or detention centers.xxiii A systems of care, “wraparound” approach is a promising practice in serving both youth with mental health challenges and juvenile offenders.xxiv This strategy provides youth and their families with an array of comprehensive, coordinated services from various agencies and organizations, rather than placing youth into predetermined, inflexible treatment programs. It substantially improves youths’ functioning in their schools, homes, and communities, and can prevent them from coming into contact with the juvenile justice system.xxv Unfortunately, with only limited community based resources, children with mental disorders frequently come into contact with the juvenile justice system.xxvi Services are out of reach to many children and families. In a national survey of families who had a child with a serious mental disorder, 36% of respondents said their child was in the juvenile justice system because of the unavailability of mental health services outside of the system; 23% were told they would have to relinquish custody of their child to get the services they believed necessary; and 20% said they actually relinquished custody to obtain services for their child.xxvii
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Keeping Mentally Ill Offenders from Entering or Penetrating the Juvenile Justice System When youth with mental health challenges engage in delinquent behavior, identifying the issue and diverting these youth from the juvenile justice system and into evidenced based community interventions–i.e., the least restrictive setting possible—benefits the youth and communities alike. Research shows many of the most effective treatment methods work best when applied in the community, while youth are with their families,xxviii whereas interventions in more restrictive residential placements are generally ineffective in producing long term changes in youth behavior.xxix Screenings and assessments: Experts recommend screenings at the earliest point of contact with the juvenile justice system possible to help divert delinquent youth with mental health challenges to appropriate and effective treatment and services. Valid screening instruments can help detect mental health issues, including substance abuse and traumatic stress disorders. Results enable juvenile probation departments or juvenile courts to better identify interventions that will most appropriately meet the youths’ and community’s needs. Community Based Interventions: Remaining in or close to their communities is important for all youth within the juvenile justice system, and perhaps even more so for youth with mental health disorders. Interventions that both address youths’ mental health needs and decrease the chance of future delinquent behavior often include individual and family therapy, medication management, behavioral coaching, and respite care. All reduce psychiatric symptoms, out of home placement, and long term rates of recidivism.xxx Evidence based approaches that work with parents, guardians, and youth at home to improve youths’ behavior include multisystemic therapyxxxi, functional family therapyxxxii, and multidimensional treatment foster carexxxiii, and coordination of services through a wraparound approachxxxiv which is integral to systems of care. Providing delinquent youth with an array of coordinated community services has been shown to result in fewer behavioral and emotional problems after 18 months in a system of care.xxxv
Screening in Texas Local probation departments in Texas are required to do an initial mental health screening when youth are admitted to detention or enter the probation system. The Texas Juvenile Probation Commission is developing a series of juvenile risk assessment instruments for identification of a juvenile’s risk of re offense based on criminal history and needs. Beginning in 2010, youth in the juvenile justice system in pilot areas will be screened for undiagnosed traumatic brain injuries (TBI) that may contribute to delinquent behavior, allowing for more targeted services. However, screenings and assessments do not guarantee treatment. Specialized treatment services are often in short supply or are too expensive for local communities. The majority of youth with mental health disorders served by local probation departments in Texas do not receive treatment. In 2004, 67% of youth served by juvenile probation departments who needed services did not receive them.
Sources: Texas Family Code Sec. 51.21; Texas Juvenile Probation Commission and Juvenile Justice Practitioners. (2008) Texas Juvenile Probation: Today and Tomorrow. http://www.tjpc.state. tx.us/publications/reports/TJPCMISC0308.pdf; Texas Juvenile Probation Commission and Juvenile Justice Practitioners. (2008) Texas Juvenile Probation: Today and Tomorrow. http://www.tjpc.state.tx.us/publications/reports/TJPCMISC03 08. pdf; Texas Juvenile Probation Commission. Models for Change: Systems Reform in Juvenile Justice Grant Application.
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Community Based Practices in Texas Role of the Judicial System in Diverting Youth: The juvenile courts play an important role in making sure delinquent youth with mental health issues receive appropriate treatment. Courts in Texas can order a mental health evaluation at any stage of court proceedings, and local probation departments are required to refer the child to the local community mental health center for further evaluation and services if testing indicates a suspected mental illness.xxxvi When families have access to adequate legal defense to help them focus on securing appropriate community based services, youth are able to remain in their homes or be placed in less restrictive settings.xxxvii Mental Health and Drug Courts are emerging as promising alternatives to more traditional courts to address juvenile offenders’ mental and substance use issues, while also addressing public safety.xxxviii Mental health courts link offenders who would ordinarily be prison bound to long term community based treatment. Drug courts provide court supervised treatment as an alternative to traditional criminal sanctions. There are several promising diversion practices underway in the state: Dallas and Harris counties are participating in the Annie E. Casey Foundation funded Juvenile Detention Alternatives Initiative (JDAI). JDAI targets the detention component of the juvenile justice system for diversion efforts by helping communities devise systems and procedures to help make sure only youth awaiting trial who need to be detained are held in detention centers and diverting other youth to community based alternatives. The Front End Diversion Initiative is an intake based diversion effort that provides family engagement, motivational interviewing, crisis intervention, and mental health training to specialized juvenile probation officers to help them better identify and work with youth with mental health challenges. The Special Needs Diversionary Program pairs a specialized probation officer with a local mental health professional to provide the offender and his/her family coordinated community based case management services, such as skills training, anger management, medication maintenance, and group therapy. The Youth Empowerment Services Medicaid waiver pilot program, being implemented in Bexar and Travis counties, will provide intensive community based services for youth and children with severe emotional disturbances to reduce out of home placements by all child serving agencies, including the juvenile justice system agencies. Bexar County is a demonstration site for a behavioral health intervention pilot project to divert children and youth at risk of being removed from their home into integrated systems of care implemented by local and state child serving agencies, including the local mental health authority and TYC.
Sources: The Annie E. Casey Foundation. (2009) Two Decades of JDAI: A Progress Report http://www.jdaihelpdesk.org/Docs/Documents/ JDAI_Natl_Report_r6.pdf; Texas Juvenile Probation Commission. (2009). Front End Diversion Initiative Program: Policy and Procedure Manual Overview; Texas Juvenile Probation Commission. (2008) Overview of the Special Needs Diversionary Program for Mentally Ill Juvenile Offenders, FY 2007.
Judicial Diversion in Texas Specialized court programs are unavailable to the majority of juveniles in Texas, but some communities are implementing this promising practice. One example is Travis County’s COPE Mental Health Court, which links youth with a mental health disorder or diagnosis that has led to the commission of a criminal offense to community mental health services, therapeutic services, and other services as needed by the family. The Bexar County Mental Health Court for Female Juvenile Offenders diverts young delinquent females who have been traumatized into treatment and away from further criminal justice system involvement. The Tarrant County Juvenile Drug Court targets juvenile offenders referred for substance abuse offenses and gives them opportunities to get support that will improve their decision making, skills, and health.
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Mental Health Treatment during Incarceration Some delinquent youth will need to be placed in secure facilities, due to concerns for public safety or chronic reoffending. However, in general, merely incarcerating youth has proven ineffective in changing behavior once they are released back into their homes and communities.xxxix Providing mental health treatment during incarceration, however, can improve outcomes. A TYC study found that youth who received mental health treatment while incarcerated were significantly less likely to be rearrested or reincarcerated after one year following their release.xl Conducting comprehensive psychological assessments on all juvenile offenders upon commitment would allow juvenile justice agencies to identify previously undiagnosed mental health needs and develop individualized treatment plans, including planning for youths’ return to their families and communities. Interventions that are tailored to the youths’ individual needs and evidenced based hold the most promise. Evidence based practices, such as cognitive behavioral therapy, specialized substance abuse treatment, integrated treatment for dually diagnosed youth, and trauma informed care, are key to treating incarcerated juvenile offenders.xli Research notes the importance of specialized treatment, provided by qualified professionals with extensive training, which has proven more effective than similar programs administered by regular correctional staff.xlii Even when youth are incarcerated, families can be involved in the treatment plan to enhance effectiveness. Small, Regional Facilities and Trained Staff: Secure juvenile justice facilities that serve a small number of offenders and are located as close to the communities youth come from as possible bring better outcomes for incarcerated youth. This practice has been implemented in the Missouri juvenile correction system and is sometimes referred to as the “Missouri Model.” Additionally, ensuring facility staff use a youth focused and strength based approach, have adequate training to work with youth (e.g., training in strategies to defuse escalating situations), and can maintain low youth to staff ratios is beneficial.xliii In contrast, the use of seclusion and restraints, including using medication as a means of chemical restraint, poses serious health and safety risks to youth, and prevents youth from learning appropriate coping skills.xliv
The Targeted Approach in Texas Youth incarcerated within TYC continue to be housed in large facilities, most often far from their families and communities. Lawmakers and advocates are closely watching the outcomes of newly implemented reforms within the Commission. In response to juvenile justice reform passed by the state legislature in 2007, TYC implemented the ConNEXTtions program, an integrated system wide rehabilitation program offering various therapeutic techniques and tools for youth in TYC facilities. ConNEXTions uses an evidence based assessment on all youth, with assessment results forming the basis for individual treatment plans. In addition to general programming, youth may be required to attend supplemental groups to assist them in areas such as mental health support, alcohol and drug education, anger management, or psychosexual development. Youth diagnosed with severe mental illness may receive treatment at one of two facilities in the state, Corsicana Residential Treatment Center or Crockett State School.
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Reentry into the Community and Aftercare Services Most youth involved in the juvenile justice system will return to their families and communities. Planning for this reentry is a critical piece in preventing them from cycling back into the juvenile or adult criminal justice systems. Experts recommend beginning planning for reentry soon after a youth enters confinement, taking into account a youth’s family and living arrangements; peer groups; mental, behavioral and physical health; substance abuse treatment needs; and educational plans.xlv Reentry planning and aftercare services following a youth’s return home are model practices in reducing recidivism rates and saving the public money in the long run.xlvi Using a wraparound approach to serve youth leaving a juvenile justice facility is a promising practice that can prevent youth with mental illness from engaging in further delinquent behavior. Such planning is needed for all youth coming out of the juvenile justice system, and it is especially critical for youth with mental health disorders to make sure they have continuing access to services and supports, including mental health treatment, substance abuse treatment, and re enrollment into health coverage. Youth coming out of the juvenile justice system face many of the same challenges as youth aging out of foster care. A new pilot for former juvenile offenders uses a promising strategy several communities are using to help former foster youth. Transition centers are community collaborations that use a one stop model to provide former foster youth with access to health care, job training, skill building, housing, education, and more.xlvii TYC and TJPC have recently partnered with community groups in San Antonio to launch the Children’s Aftercare Reentry Experience (CARE) Project that will provide youth coming out of the juvenile justice system with access to these services through San Antonio’s transitional center. Reentry Services in Texas During its 2009 session, the state legislature enacted several laws to help youth with mental illness leaving the juvenile justice system access supports and services critical to their successful reentry. State agencies are now required to work together to determine a youth’s eligibility for public health benefits upon release as part of the discharge planning process, helping to ensure that qualifying youth can access health care. The Texas Correctional Office on Offenders with Medical or Mental Impairments (TCOOMMI) contracts with public mental health agencies to provide juvenile offenders with serious emotional disturbances with targeted treatment services using a wraparound, case management philosophy, with strong emphasis on flexible programming. TCOOMMI is now also required to coordinate a continuity of care system for juvenile offenders. This continuum of care is to be delivered by various state child serving agencies, including juvenile justice, human services, and education agencies. The continuity of care system was established to address the medical, psychiatric, or psychological needs and care of juvenile offenders with mental illness, along with their education and rehabilitation needs, from the time they enter the enter the juvenile justice system until they are released from supervision into their communities. The state legislature also authorized TCOOMMI to provide community services to youth discharged from TYC due to a mental impairment that precludes them from effectively participating in rehabilitative services. These youth, arguably in the greatest need of ongoing mental health treatment and supports, were previously ineligible for aftercare services through TCOOMMI because they were not placed on parole after discharge.
Sources: Texas Correctional Office on Offenders with Mental or Medical Impairments. (2009). The Biennial Report of the Texas Correctional Office on Offenders with Medical and Mental Impairments. http://www.tdcj.state. tx.us/publications/tcomi/Biennial%20Report%202009%20FINAL.pdf; Texas Health and Safety Code, Section 614.018
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Special Issues and Considerations Co occurring Disorders: Many youth involved with the juvenile justice system have co occurring mental health and substance abuse disorders. Youth with emotional and behavioral problems are almost four times as likely to be dependent on alcohol or drugs, compared to their peers.xlviii Screening and assessment tools used throughout the juvenile justice process can be designed to detect various disorders, including trauma and substance abuse problems. When co occurring disorders are present, integrated treatment is necessary, as are professionals who can effectively treat the multiple needs of youth. Because some youth may return to homes and friends that promoted or supported their drug use, aftercare and relapse prevention services are critical. Youth who continue their substance use upon reentry are more likely to reoffend, and treatment for substance use can reduce continued criminal behavior.xlix Treatment of Young Female Offenders: While females make up a small percentage of youth incarcerated by TYC (just 7% of commitments in 2008), over a quarter of youth referred to TJPC in 2005 were female.l No matter where they are served, young female offenders have different treatment and rehabilitation needs than their male peers.li Young female offenders are more likely to report being the victims of violence and to develop mental health problems following trauma than male juvenile offenders.lii Girls should have access to community based treatment that is gender specific and trauma informed.liii Family Involvement: Having families involved in all aspects of care and treatment for youthliv can help mental health professionals have valuable information key to keeping the youth stable and safe. Even more importantly, families can play an integral, if not essential, part of youths’ treatment and rehabilitation. Multisystemic therapy and functional family therapy, both evidenced based best practices for working with delinquent youth, work with parents, guardians, and youth at home to improve the youth’s behavior and the communication and problem solving skills of parents and siblings. Since most youth return to their families after they leave the juvenile justice system, it is necessary to involve families in planning for successful reentry into their home and community. Families also play a key role in the systems of care approach for youth with serious emotional disturbances. Family partners and family liaisons are valuable approaches to both assist and engage families in supporting their youths’ treatment. To facilitate their involvement, families need information, training, and support at all stages of their child’s experience with the juvenile justice system. Many of Texas’s child and youth serving agencies recognize this and have begun to staff or contract with experienced parents or young adults who have had life experiences and a personal working knowledge of accessing and utilizing the state’s health and human services or juvenile justice systems. These professionals help families navigate the systems to access services. Disproportionate Minority Contact: Youth of color face particular challenges in both the mental health and juvenile justice systems. Compared to their white peers, they are less likely to receive services for mental health concerns;lv when they do receive treatment, it is less likely to be care shown to be effective.lvi Even when evidence based treatments are available, they may not be treatments that have been shown to be effective with youth of color.lvii At the same time, youth of color are overrepresented in the juvenile justice system, nationally and in Texas.lviii,lix While referrals to juvenile probation departments in Texas have decreased by 12% since 2001, the reduction has been almost solely driven by a drop in referrals of white youth; youth of color are referred at roughly the same rate as in previous years.lx Minority students are more likely to receive disciplinary referrals in Texas schools,lxi and they are more likely to be put on probation.lxii The factors influencing the experiences of youth of color within both systems are complex,lxiii but involve practices both in the community, such as differences in school discipline practices that disparately impact youth of color, and in care, such as biases in the legal and justice systems that lead to different outcomes across racial and ethnic groups. Policy and practice 8
must address the gaps in front end contact with the juvenile justice system, as well as ensure the cultural competence of treatment for youth in care. Investing in What Works: Thanks to a growing body of research, much is known about how to effectively address the mental health needs of youth, both in the community and within the juvenile justice system. To ensure the best outcomes for children and families and to make the most of limited public resources, investments need to be linked to evidence based programs, as well as emerging practices that show promise but need further evaluation. Across all programs and systems, objective evaluations, routinely conducted, can help measure progress in client outcomes and to determine cost effectiveness. Return on Investment Community based treatments for youth with mental health challenges are more effective and less expensive than treatments provided in more restrictive environments, such as juvenile justice facilities. Various juvenile delinquency prevention programs have been shown to be effective in not only reducing juvenile criminal behavior, but in saving money by avoiding costs in the juvenile justice system and to victims of juvenile crime.lxiv In 2005, it cost an average of $885 to provide youth with behavioral health services in a community setting in Texas, compared to $8,759 to provide behavioral health services in institutional or residential settings.lxv The average cost to commit a youth to the Texas Youth Commission is $96,000,lxvi compared to approximately $3,000 for providing drug or alcohol rehabilitation.lxvii Separately, untreated mental illness in children and delinquent behavior each inflict a great cost to the public. Since mental health and juvenile delinquency are related and often interconnected, Texas can reap multiple benefits by addressing these issues together. Recommendations To promote resiliency and success in children, keep citizens safe from delinquent activity, and save taxpayers money, Texas should act to ensure children with mental impairments are diverted from the juvenile justice system whenever possible; we must also ensure those who do enter the system receive quality care and that their needs are met as they transition out of the system. DIVERSION Promote school success by requiring school districts to use evidence based models, such as school wide Positive Behavioral Supports, and to train teachers and school staff to recognize potential unmet mental health needs, so they can make appropriate referrals. Continue to repeal zero tolerance policies that criminalize challenging behavior in the school environment. Support keeping kids in the community by making Mobile Crisis Teams available on school campuses. Build community capacity to address mental health needs of children and families, including evidence based treatments addressing the whole child. Decrease reliance on psychotropic medication to control behaviors in children. When such medication is deemed necessary, ensure that its usage is closely monitored and provided in conjunction with other interventions. Improve coordination among agencies and systems serving children and their families. Use multidisciplinary teams as standard practice for assessment and service delivery. Provide flexible funding for Community Resource Coordination Groups (CRCGs) and Texas Integrated Funding Initiative (TIFI)
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sites to provide more children with complex needs access to needed supports and services using a systems of care approach. Expand probation based diversion strategies, such as the Front End Diversion Initiative, to all counties, with specialized officer certification that includes motivational interviewing. Increase use of mental health and drug courts and move all juvenile courts towards treatment based models Ensure that all practices reduce the disproportionate referral of children of color to the juvenile justice system. Make the primary objective of probation supervision rather than sanction. IN CARE Identify youth with mental health challenges when they come into the system. Provide evidence based treatment, such as Cognitive Behavioral Therapy, Multisystemic Therapy, Functional Family Therapy, trauma informed care, and substance abuse treatment. Involve guardians and family of choice in all aspects of youth care. Strategies to better engage families include training juvenile justice staff on how to effectively engage families, exploring the use of family group decision making, and using technology, such as video conferencing, to keep families engaged with incarcerated youth. Given the prevalence of trauma among young female offenders, provide them with community based treatment that is gender specific and trauma informed. In order to address their unique needs, keep children out of the adult criminal justice system. Utilize programs and practices that are culturally competent. Use seclusion and restraints only when there is an imminent risk of danger to the youth or others and no other safe and effective intervention is possible. Medication should not be used as a chemical restraint. Serve youth in small, regionalized facilities close to their communities. Partner with community based organizations to keep youth connected to the community and involved in activities that foster responsibility and self esteem. Promote professionalism among juvenile justice staff. Increase professional requirements, including field experience and training in working with special populations; pay a living wage; and reward staff who work effectively with youth. TRANSITION Begin planning for reentry upon confinement. Provide comprehensive aftercare services to youth coming out of the juvenile justice system to make sure a continuum of care and services is available. Identify and engage a child’s family of choice and help them prepare for the child’s reentry into the community. Take steps to ensure eligible youth are enrolled in Medicaid or CHIP and can begin receiving covered services immediately upon release. Assist youth leaving the juvenile justice system in acquiring the skills and resources needed to succeed in reentry and to prevent recidivism. Provide grants to community based organizations that assist youth in enrolling in school or training; securing employment and safe, stable housing; accessing mental health services; and resolving substance abuse problems. Explore the use of transition centers, such as those serving youth leaving the child welfare system, to assist youth leaving the juvenile justice system. 10
Kessler, R.C.; Berglund, P.; Demler, O.; Jin, R.; Walters, E.E. (2005) Life time Prevalence and Age of onset Distribution of DSM IV Disorders in the National Co morbidity Survey Replication. Archives of General Psychiatry. 62:539 602. ii US Census Bureau. (2009) Income, Poverty, and Health Insurance Coverage in the United States: 2008 http://www.census.gov/prod/2009pubs/p60 236.pdf iii Department of State Health Services. 2007. E mail correspondence with Amanda Broden. iv National Center for Children in Poverty.(2009) Adolescent Mental Health in the United States. http://www.nccp.org/publications/pdf/text_878.pdf v Texas Juvenile Probation Commission.(2008) Models for Change: Systems Reform in Juvenile Justice Grant Application. vi Texas Youth Commission. Who Are TYC Offenders (FY08) http://www.tyc.state.tx.us/research/youth_stats.html vii Texas Juvenile Probation Commission Strategic Plan for 2009 2013 http://www.tjpc.state.tx.us/publications/reports/RPTSTRAT200801.pdf; Texas Youth Commission Review of Agency Treatment Effectiveness, Fiscal Year 2008. viii Texas Juvenile Probation Commission. Models for Change: Systems Reform in Juvenile Justice Grant Application. ix Texas Appleseed. (2009) Creating Flexibility from the Bench: Meeting the Needs of Juveniles with Mental Impairments. http://www.texasappleseed.net x Lavigne J.V., Binns, H.J., Christoffel, K,K. et al. (1993). “Behavioral and emotional problems among preschool children in pediatric primary care: Prevalence and pediatricians’ recognition.” Pediatrics. 91:649 657, as cited in Improving Developmental Screening Through Public Policy http://www.dbpeds.org/articles/detail.cfm?TextID=367 xi Koppelman, Jane. (2005). Mental Health and Juvenile Justice: Moving Toward More Effective Systems of Care. National Health Policy Forum Issue Brief No. 805 xii Texas CHIP Coalition. (2009). Fiscal Facts: Texas CHIP and Children’s Medicaid. http://www.texaschip.org/pdf/Fiscal%20Facts%20 %20CHIP%20and%20Childrens%20Medicaid.pdf xiii Horner, R., Sugai, G., Smolkowski, K., Eber, L., Nakasato, J., Todd, A., and J. Esperanza. (2009). A Randomized, Wait List Controlled Effectiveness Trial Assessing School Wide Positive Behavior Support in Elementary Schools, Journal of Positive Behavior Interventions. Journal of Positive Behavior Interventions, Vol. 11, No. 3, 133 144 ; Sprague, J., and R. Horner (2007) “School Wide Positive Behavioral Supports”, in The Handbook of School Violence and School Safety: From Research to Practice. Shane R. Jimerson & Michael J. Furlong, eds. xiv U.S. Department of Education. (2000). Applying positive behavioral support in schools: Twenty second Annual Report to Congress on the Implementation of the Individuals with Disability Act. xv Springer, D. (2007 Transforming Juvenile Justice in Texas: A Framework for Action – Blue Ribbon Taskforce Report. http://www.dallasnews.com/s/dws/img/09 07/0913tycreport.pdf xvi Public Policy Research Institute, Texas A&M (2005) Study of Minority Over Representation in the Texas Juvenile Justice System. http://dmcfinalreport.tamu.edu/DMRFinalReport.pdf xvii Texas Appleseed. (2009) Creating Flexibility from the Bench: Meeting the Needs of Juveniles with Mental Impairments. http://www.texasappleseed.net xviii Texas Juvenile Probation Commission. (2008) Today and Tomorrow: A Report by the Texas Juvenile Probation Commission and Juvenile Justice Practioners. http://www.tjpc.state.tx.us/publications/reports/TJPCMISC0308.pdf xix National Conference of State Legislatures. (2005). Positive Youth Development: State Strategies. http://www.ncsl.org/Portals/1/documents/cyf/final_positive_youth_development.pdf xx Social Development Research Group, University of Washington. Positive Youth Development in the United States : Research Findings on Evaluations of Positive Youth Development Programs http://aspe.hhs.gov/hsp/PositiveYouthDev99/chapter4.htm xxi Board on Children, Youth and Families. (2002) Community Programs to Promote Youth Development. http://books.nap.edu/openbook.php?record_id=10022&page=1 xxii Promising Practices Network, http://www.promisingpractices.net; National Evaluation Program of the Comprehensive Community Mental Health Services Program for Children and Their Families, Matrix of Children’s Evidence Based Interventions http://systemsofcare.samhsa.gov/headermenus/docsHM/MatrixFINAL1.pdf; Washington State Institute for Public Policy. (2004) Benefits and Costs of Prevention and Early Intervention Programs for Youth. http://www.wsipp.wa.gov/rptfiles/04 07 3901.pdf xxiii Burns, B. & Hoagwood, K. (Eds.). (2002). Community treatment for youth: Evidence based interventions for severe emotional and behavioral disorders. New York: Oxford University Press.
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Pires, S. 2002. Building a Systems of Care: A Primer. National Technical Assistance Center for Children’s Mental Health, Center for Child Health and Mental Health Policy, Georgetown University Child Development Center.; Office of Juvenile Justice and Delinquency Prevention Model Programs Guide. xxv Office of Juvenile Justice and Delinquency Prevention Model Programs Guide. http://www.ojjdp.ncjrs.gov/programs/mpg.html xxvi Texas Appleseed (2009). Creating Flexibility from the Bench: Meeting the Needs of Juveniles with Mental Impairments. http://www.texasappleseed.net xxvii National Alliance for the Mentally Ill (NAMI). (1999). Families on the Brink: The Impact of Ignoring Children with Serious Mental Illness: Results of a National Survey of Parents and Other Caregivers. Arlington, VA: National Alliance for the Mentally Ill. http://www.nami.org/Template.cfm?Section=Child_and_Adolescent_Action_Center&template=/ContentManagement/Con tentDisplay.cfm&ContentID=22196 xxviii Grisso, Thomas. (2008) “Adolescent Offenders with Mental Disorders”. Juvenile Justice, Vol. 18, No. 2. The Future of Children. www.futureofchildren.org xxix National Health Policy Forum. (2005). Mental Health and Juvenile Justice: Moving Toward More Effective Systems of Care. http://www.nhpf.org/library/issue briefs/IB805_JuvJustice_07 22 05.pdf xxx National Health Policy Forum. (2005). Mental Health and Juvenile Justice: Moving Toward More Effective Systems of Care. http://www.nhpf.org/library/issue briefs/IB805_JuvJustice_07 22 05.pdf ; Texas Appleseed (2009). Creating Flexibility from the Bench: Meeting the Needs of Juveniles with Mental Impairments. http://www.texasappleseed.net xxxi Promising Practices Network. http://www.promisingpractices.net/program.asp?programid=81 xxxii Listed as a model program by the Office of Juvenile Justice and Delinquency Prevention; also, Alexander, J.F.; C. Barton; D. Gordon; J. Grotpeter; K. Hansson; R. Harrison; S. Mears; S. Mihalic; B. Parsons; C. Pugh; S. Schulman; H. Waldron; and T. Sexton. (1998). Blueprints for Violence Prevention, Book Three: Functional Family Therapy. Boulder, Colo.: Center for the Study and Prevention of Violence. xxxiii Listed as a model program by the Office of Juvenile Justice and Delinquency Prevention. Also, Chamberlain, Patricia, and Sharon F. Mihalic. 1998. “Multidimensional Treatment Foster Care.” In D.S. Elliott (series ed.) Blueprints for Violence Prevention, Book 8: Multidimensional Treatment Foster Care. Boulder, Colo.: Center for the Study and Prevention of Violence. xxxiv Listed as a model program by the Office of Juvenile Justice and Delinquency Prevention. xxxv National Evaluation Program of the Comprehensive Community Mental Health Services Program for Children and Their Families, Matrix of Children’s Evidence Based Interventions http://systemsofcare.samhsa.gov/headermenus/docsHM/MatrixFINAL1.pdf xxxvi Texas Family Code Sec. 51.20 xxxvii Springer, D. (2007) Transforming Juvenile Justice in Texas: A Framework for Action – Blue Ribbon Taskforce Report. http://www.dallasnews.com/s/dws/img/09 07/0913tycreport.pdf xxxviii National Center for Mental Health and Juvenile Justice. (2006) Juvenile Mental Health Courts: An Emerging Strategy. http://www.ncmhjj.com/pdfs/publications/JuvenileMentalHealthCourts.pdf; Council of State Governments Justice Center (2008). Mental Health Courts: A Primer for Policy Makers and Practitioners. http://consensusproject.org/mhcp/mhc primer.pdf; Office of Juvenile Justice and Delinquency Prevention. xxxix National Health Policy Forum. (2005). Mental Health and Juvenile Justice: Moving Toward More Effective Systems of Care. http://www.nhpf.org/library/issue briefs/IB805_JuvJustice_07 22 05.pdf xl Texas Youth Commission. (2008) Fiscal Year 2008 Review of Agency Treatment Effectiveness. http://www.tyc.state.tx.us/archive/Research/2008_Treatment_Effectiveness.pdf xli Springer, D. (2007) Transforming Juvenile Justice in Texas: A Framework for Action – Blue Ribbon Taskforce Report. http://www.dallasnews.com/s/dws/img/09 07/0913tycreport.pdf; National Center for Mental Health and Juvenile Justice. (2007). “Trauma Among Youth in the Juvenile Justice System: Critical Issues and New Directions.” Research and Program Brief. http://www.ncmhjj.com/pdfs/Trauma_and_Youth.pdf xlii Greenwood, Peter. (2008) “Prevention and Intervention Programs for Juvenile Offenders”. Juvenile Justice, Vol. 18, No. 2. The Future of Children. www.futureofchildren.org
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Springer, D. (2007) Transforming Juvenile Justice in Texas: A Framework for Action – Blue Ribbon Taskforce Report. http://www.dallasnews.com/s/dws/img/09 07/0913tycreport.pdf xliv Donat, D. (2005). “Encouraging alternatives to seclusion, restraint, and reliance on PRN drugs in a public hospital.” Psychiatric Services, 56(9), 1105 1108. xlv Urban Institute Justice Policy Center. (2004). The Dimensions, Pathways, and Consequences of Youth Reentry. xlvi Springer, D. (2007) Transforming Juvenile Justice in Texas: A Framework for Action – Blue Ribbon Taskforce Report. http://www.dallasnews.com/s/dws/img/09 07/0913tycreport.pdf; Urban Institute Justice Policy Center (2004). The Dimensions, Pathways, and Consequences of Youth Reentry. http://www.urban.org/UploadedPDF/410927_youth_reentry.pdf xlvii The Department of Family and Protective Services. http://www.dfps.state.tx.us/Child_Protection/Transitional_Living/forms.asp#transition xlviii U. S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (1999). The Relationship Between Mental Health and Substance Abuse Among Adolescents. Office of Applied Studies. http://www.oas.samhsa.gov/nhsda/a 9/toc.htm xlix Models for Change: Systems Reforms in Juvenile Justice. (2009). Research on Pathways to Desistance: Research Update Created for the 4th Annual Models for Change National Working Conference. http://www.macfound.org/atf/cf/%7Bb0386ce3 8b29 4162 8098 e466fb856794%7D/PATHWAYSREPORT.PDF l Texas Juvenile Probation Commission. (2008) Today and Tomorrow: A Report by the Texas Juvenile Probation Commission and Juvenile Justice Practitioners. http://www.tjpc.state.tx.us/publications/reports/TJPCMISC0308.pdf li National Center for Mental Health and Juvenile Justice. (2003) Adolescent Girls with Mental Health Disorders Involved in the Juvenile Justice System. Research and Program Brief. http://www.ncmhjj.com/pdfs/adol_girls.pdf lii The National Child Traumatic Stress Network. (2004) Trauma Among Girls in the Juvenile Justice System. http://www.nctsnet.org/nctsn_assets/pdfs/edu_materials/trauma_among_girls_in_jjsys.pdf liii Alexander, M. (1996) “Women with Co occurring Addictive and Mental Disorders: An Emerging Profile of Vulnerability. American Journal of Orthopsychiatry, 66, 1; The National Child Traumatic Stress Network. (2004) Trauma Among Girls in the Juvenile Justice System. http://www.nctsnet.org/nctsn_assets/pdfs/edu_materials/trauma_among_girls_in_jjsys.pdf liv National Center for Mental Health and Juvenile Justice. (2002). Involving Families of Youth Who Are in Contact with the Juvenile Justice System. http://www.ncmhjj.com/pdfs/publications/Family.pdf lv Ringel, J. S. & Sturm, R. (2001). National estimates of mental health utilization for children in 1998. Journal of Behavioral Health Services & Research, 28(3), pp. 319 333. lvi Institute of Medicine of the National Academies. (2006). Improving the Quality of Health Care for Mental and Substance Use Conditions: Quality Chasm Series. lvii National Council of La Raza (2008). Overcoming Language and Culture Barriers Using Evidence Based Practice. Prepared for MacArthur Foundation, Models for Change. Washington, DC. lviii National Council of State Legislatures. (2009) Minority Youth in the Juvenile Justice System Disproportionate Minority Contact. http://www.modelsforchange.net/publications/183/Minority_Youth_in_the_Juvenile_Justice_System_Disproportionate_M inority_Contact.pdf lix Texas Juvenile Probation Commission. (2009). The State of Texas Juvenile Probation Activity in Texas – 2007. http://www.tjpc.state.tx.us/publications/reports/RPTSTAT2007.pdf lx Texas Youth Commission and Texas Juvenile Probation Commission Coordinated Strategic Plan. Executive Planning Committee Meeting Packet. October 7, 2009. lxi Texas Appleseed. (2007) Texas’ School to Prison Pipeline: Drop Out to Incarceration. The Impact of School Discipline and Zero Tolerance. http://www.texasappleseed.net/pdf/Pipeline%20Report.pdf lxii Texas Juvenile Probation Commission. (2009). The State of Texas Juvenile Probation Activity in Texas – 2007. http://www.tjpc.state.tx.us/publications/reports/RPTSTAT2007.pdf lxiiilxiii United States Public Health Service Office of the Surgeon General (2001). Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: Department of Health and Human Services, U.S. Public Health Service; and Piquero, Alex. (2008). “Disproportionate Minority Contact”. Juvenile Justice. Vol. 18(2). The Future of Children:Princeton Brookings.
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Washington State Institute for Public Policy. (2001) Comparative Costs and Benefits of Programs to Reduce Crime. http://www.wsipp.wa.gov/pub.asp?docid=01 05 1201 lxv Calculation based on data in Legislative Budget Board 2007 Texas State Government Effectiveness and Efficiency Report; “Create a Coordinated State Infrastructure to Support Children’s Behavioral Health Services”. Figure 5.. http://www.lbb.state.tx.us/Performance%20Reporting/TX_Govt_Effective_Efficiency_Report_80th_0107.pdf lxvi Calculation based on information in the Texas Youth Commission 2009 2013 Agency Strategic Plan. http://www.tyc.state.tx.us/about/strategic_plan.html lxvii Schneider Institute for Health Policy. Brandeis University. (2001) Substance Abuse, The Nation’s Number One Health Problem. http://www.rwjf.org/files/publications/other/SubstanceAbuseChartbook.pdf
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